Hogg Elliot, Wertheimer Jeffrey, Graner Sarah, Tagliati Michele
Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Int Rev Neurobiol. 2017;134:1045-1089. doi: 10.1016/bs.irn.2017.05.022. Epub 2017 Jul 3.
Deep brain stimulation (DBS) is currently the treatment of choice for advanced Parkinson's disease (PD). Several brain targets, including the subthalamic nucleus and the globus pallidus internus, have been successfully employed, with excellent motor outcomes. Despite less established knowledge, DBS may be a powerful tool for managing a wide variety of nonmotor symptoms (NMS) in PD patients, either directly or indirectly due to motor benefit or reduction of dopaminergic drug load. After an assessment of global nonmotor outcomes of DBS, as measured by currently available clinical scales and questionnaires, this chapter will address DBS effects on four main NMS categories: neurobehavioral, including cognitive and neuropsychiatric symptoms, autonomic dysfunction, including orthostatic hypotension, constipation, and urinary dysfunction, sleep disturbances, including insomnia, REM sleep behavior disorder, and restless leg syndrome, to conclude with sensory symptoms, mainly focusing on pain. An overall positive impact of DBS on most NMS emerges from the reviewed studies. However, current opinion on the effect of DBS on NMS in PD needs to be tempered by the relatively low number of cases and the lack of large, controlled, specifically designed studies for most NMS categories.
深部脑刺激（DBS）目前是晚期帕金森病（PD）的首选治疗方法。包括丘脑底核和苍白球内侧部在内的几个脑靶点已成功应用，运动效果良好。尽管了解较少，但由于运动益处或多巴胺能药物负荷的降低，DBS可能是管理PD患者各种非运动症状（NMS）的有力工具，无论是直接还是间接作用。在通过目前可用的临床量表和问卷评估DBS的整体非运动结果后，本章将探讨DBS对四类主要NMS的影响：神经行为症状，包括认知和神经精神症状；自主神经功能障碍，包括体位性低血压、便秘和排尿功能障碍；睡眠障碍，包括失眠、快速眼动睡眠行为障碍和不宁腿综合征；最后是感觉症状，主要关注疼痛。综述研究表明DBS对大多数NMS具有总体积极影响。然而，由于病例数量相对较少，且针对大多数NMS类别缺乏大型、对照、专门设计的研究，目前关于DBS对PD患者NMS影响的观点仍需谨慎对待。
